CMS

Post-PAMA: Government Report Warns of Medicare Overspending(!) for Lab Tests

As if the deep price cuts inflicted by PAMA weren't infuriating enough, now the US Government Accountability Office (GAO) is claiming that labs may be getting overpaid. In a report issued late … [Read more...]

PAMA

Medicare Reimbursement: ACLA Court Appeal Maintains 2-Front War for PAMA Relief

It's official. The ACLA is appealing the September federal court decision to dismiss its PAMA lawsuit (ACLA v. Azar). Here's a quick rundown of the three things you need to know. 1. The Legal … [Read more...]

PAMA

Medicare Reimbursement: CMS Offers Some PAMA Relief But Not Nearly Enough

The final 2019 Clinical Laboratory Fee Schedule (CLFS) (Final Rule) is out and it's just as bad as last year's. Here's a rundown of what lab compliance and reimbursement managers need to know. CMS's … [Read more...]

FOCUS ON

Medicare Reimbursement: 2019 CLFS Offers Some PAMA Relief But Not Nearly Enough

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests is intensifying notwithstanding the ACLA's recent court loss and the supposed relief offered by the agency in its … [Read more...]

FEE SCHEDULES

Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]

PAMA

Medicare Reimbursement: Part B Lab Payments in Final Year before PAMA

Part B payments for lab tests in 2017, the final year under the old reimbursement rules, totaled $7.1 billion, up slightly from the $6.8 billion Medicare paid in 2016 and little changed over the … [Read more...]

REIMBURSEMENT

Labs Need to Prepare for Upcoming PAMA Data Collection Period

The impact of PAMA (the Protecting Access to Medicare Act) is already being felt in the laboratory industry. The estimates are bleak. Three-fourths of codes on the Clinical Lab Fee Schedule are now … [Read more...]

FEE SCHEDULES

Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem

CMS recently issued its annual proposed rule on 2019 Medicare Part B reimbursement. For many labs, the number one concern is the proposed extension of the controversial PAMA "market pricing" scheme to … [Read more...]

FALSE CLAIMS

PAMA: ACLA Loses Court Lab Fees Battle But May Still Win Regulatory War

It was a long shot to begin with. But that doesn't ease the disappointment of what happened in a Washington, DC courtroom when a federal judge tossed a lab industry lawsuit challenging the legality of … [Read more...]

CMS

Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments

On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]


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